Retraction is seen as a flattening, withdrawal, or inversion of the nipple and indicates inward pulling by ___ or ___

inflammatory or malignant tissue

The fibrotic tissue of ___ can also change the axis of the nipple, causing it to point in a direction different from that of the other nipple.

carcinoma

Supernumerary nipples, which are more common in __ women than in ___ women, appear as one or more extra nipples located along the ______

black>white, embryonic mammary ridge (the "milk line")

In some cases, supernumerary nipples may be associated with ___ or ___, particularly in whites.

congenital renal or cardiac anomalies

Seated with arms over the head or flexed behind the neck: This adds __________, accentuates dimpling, and may reveal variations in contour and symmetry

tension to the suspensory ligaments

Seated with hands pressed against hips with shoulders rolled forward (or alternatively have the patient push her palms together): This _______, which can reveal deviations in contour and symmetry

contracts the pectoral muscles

Seated and leaning forward from the waist: This also causes ____. The breasts should hang equally. This maneuver can be particularly helpful in assessing the contour and symmetry of large breasts, because the breasts fall away from the chest wall and hang freely. As the patient leans forward, support her by the hands

tension in the suspensory ligaments

sentinel nodes___

Virchow nodes

___ nodes are the first sign of invasion of the lymphatics by abdominal or thoracic carcinoma

Virchow

Where are the Virchow nodes?

supraclavicular fossa

Where is the tail of Spence?

upper outer quadrant of the breast with tissue extending from this quadrant into the axilla

In the ___ technique, begin at the top of the breast and palpate, first downward, then upward, working your way down over the entire breast

vertical strip

In the ____ technique, begin at the outermost edge of the breast tissue and spiral your way inward toward the nipple

concentric circle

To use the ___, palpate from the center of the breast in radial fashion, returning to the areola to begin each spoke

wedge method

____ can be used to confirm the presence of fluid in certain masses.

Transillumination

Nipple compression should be performed only if the patient reports_____.

spontaneous nipple discharge, especially if unilateral

chemoprevention for breast cancer

Tamoxifen

In infants, If you squeeze the breast bud gently, a small amount of clear or milky white fluid, commonly called "____," is sometimes expressed.

witch's milk

Many males at puberty have transient unilateral or bilateral ___ masses

subareolar

Gynecomastia can be associated with the use of either___ or ___.

illicit or prescription drugs

During the second trimester, vascular spiders may develop on the upper chest, arms, neck, and face as a result of __________.

elevated levels of circulating estrogen

In Lactating Women, Engorgement is not an unusual condition in the first 24 to 48 hours after the breasts fill with milk; however, its later development may signal the onset of ___

mastitis.

A clogged duct left unattended will probably result in the development of ___

mastitis.

Breast changes in older adults

flattened, elongated, and suspended more loosely from the chest wall as the result of glandular tissue atrophy and relaxation of the suspensory ligaments

Hormone replacement therapy can result in____, which can be painful.

fluid-filled breast cysts

_______ caused by ductal enlargement is associated with a long follicular or luteal phase of the menstrual cycle. The lesions are filled with fluid and are usually bilateral and multiple.

FIBROCYSTIC CHANGES

Fibrocystic disease occurs most commonly in women between ___ years of age

30 and 55

___ are benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit.

Fibroadenomas

___ may occur in girls and women of any age during their reproductive years and account for the majority of breast tumors in young women. generally asymptomatic and do not change with the menstrual cycle.

Fibroadenomas

___ rarely appear in older women; therefore any new solid lesion in an older woman should be considered malignant until proven otherwise

Fibroadenomas

Peak incidence of malignancy is between ages___ years, with the majority of malignant breast tumors occurring in women older than 50 years of age

40 and 75

About 80% of patients with breast cancer have a___ in the breast as the initial symptom

painless lump

mass or thickening in the breast; marked asymmetry of breasts; prominent unilateral veins; discolorations (erythema or ecchymosis); peau d'orange; ulcerations; dimpling, puckering, or retraction of skin or areola; fixed inversion or deviation in position of the nipple; crusting or erosion of the nipple or areola; or change in surface characteristics (e.g., moles or scars)

findings associated with breast cancer

____ is a response to local injury. It is felt as a firm, irregular mass, often appearing as an area of discoloration

Fat necrosis

These benign 2- to 3-cm tumors of the subareolar ducts may occur singly or in multiples. common cause of serous or bloody nipple discharge. They need to be excised and examined to rule out malignancy.

INTRADUCTAL PAPILLOMAS AND PAPILLOMATOSIS

____ of the breast is a surface manifestation of underlying ductal carcinoma. A red, scaling, crusty patch forms on the nipple, areola, and surrounding skin. The lesion appears eczematous but, unlike eczema, may occur unilaterally, and does not respond to steroids

Paget disease

___ is a smooth, firm, mobile, tender disk of breast tissue located behind the areola in males. It may be unilateral or bilateral. In adult men it can be caused by hormone imbalance; by testicular, pituitary, or hormone-secreting tumors; by liver failure; or by antihypertensive medications or those containing estrogens or steroids

Gynecomastia

Inflammation of the sebaceous glands in the areola results in ______. They may become tender and suppurative

RETENTION CYSTS

Lactation not associated with childbearing is most commonly caused by drugs, especially ___, __, ___, __

Prepubertal breast enlargement of unknown cause in girls can occur in the absence of other signs of sexual maturation. The degree of enlargement varies from very slight to fully developed breasts. It usually occurs bilaterally, with the breasts continuing to enlarge slowly throughout childhood until full development is reached during adolescence

PREMATURE THELARCHE

___ is inflammation and infection of the breast tissue characterized by sudden onset of swelling, tenderness, erythema, and heat; it is usually accompanied by chills, fever, and increased pulse rate.

Mastitis

Mastitis is most common in lactating women after milk is established, usually the ___ week after delivery; however, it may occur at any time

second to third

Common strain for Mastitis

Staphylococcus aureus

In Mastitis, The underlying ___ may impart a bluish tinge to the skin

pus-filled abscess

_____occurs most commonly in menopausal women. The subareolar ducts become blocked with desquamating secretory epithelium, necrotic debris, and chronic inflammatory cells. This condition is often bilateral and is characterized by pain, tenderness, periods of inflammation, and a nipple discharge that is spontaneous, sticky, multicolored, and from multiple ducts. Nipple retraction may occur. There is no known association with malignancy.